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Failure to thrive malnutrition paedia . pptx
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- 3. INTRODUCTION Failure to thrive(FTT) is a chronic, potentially life threatening disorder of infants and children who fail to gain and may even lose weight. Children are considered as failing to thrive when their rate of growth does not meet the expected growth rate for a child of their age. More specifically, the term characterized those whose weight is below the 3rd percentile on an appropriate growth chart.
- 5. The deviation froma normal growth channel is actually more descriptive of what is happening to an individual than a decrease in the actual amount of weight. Any infant or child at the fifth percentile should alert the caregiver that a problem exists. If the condition progresses, the undernourished child may become irritable and/or apathetic and may not reach typical developmental markers such as sitting up, walking, and talking at the usual ages.
- 6. DEFINITION FTT is aterm used to describe inadequate growth or the inability to maintain growth in childhood.Attained growth• Weight<3rd percentile on standard growth chart.• Weight for height<5th percentile on standard growth chart.• Weight 20% or more below ideal weight for height.Rate of growth• Less than 20g/day from birth to 3 months of age.• Less than 15g/day from 3 months to 6 months of age.• Fall off from previously established growth curve.• Downward crossing of >2 major percentiles.
- 7. CLASSIFICATION OF FTT Classificationof FTT03Traditionally FTT has been classified as ° Organic ° Inorganic ° Mixed
- 8. ORGANIC • Occurs whenthere is underlying medical cause like: • Premature birth. • Maternal smoking, alcohol use or illicit drugs during pregnancy. • Mechanical problems present. • Unexplained poor appetites that are unrelated to mechanical problems. • Inadequate intake also can result from metabolic abnormalities. • Poor absorption of food, inability of the body to use absorbed nutrients or increased loss of nutrients.
- 9. INORGANIC Due to causesother than medical cause • Poor feeding skills on the part of the parent • Dysfunctional family interactions • Difficult parent-child interactions • Lack of social support • Lack of parenting preparation • Family dysfunction, such as abuse or divorce • Child neglect • Emotional deprivation
- 10. MIXED Has both organicand inorganic causes and can’t be described alone.
- 11. CAUSES OF FTT 1•Inadequate caloric intake 2• Inadequate absorption 3• Increased caloric requirement 4•Excessive loss of calories 5• Altered growth potential or regulation
- 12. 1. INADEQUATE CALORICINTAKE • CR Incorrect formula preparation • Neglect • Excessive juice consumption • Poverty • Behavioral problem affecting eating • Non-availability of food • Misperceptions about diet and feeding practices • Errors in formula reconstitution
- 13. • Dysfunctional parent-childinteraction, child abuse and neglect • Behavioral feeding problem • Mechanical problems with sucking, swallowing and feeding • Primary neurological diseases • Chronic systemic disease resulting in anorexia, food refusal and neurological problems
- 14. 2. INADEQUATE ABSORPTION •Cystic fibrosis • Celiac disease • Vitamin deficiencies • Hepatic diseases.
- 15. 3. INCREASED CALORICINTAKE • Hyperthyroidism • Congenital heart disease • Chronic immunodeficiency • Chronic respiratory disease • Neoplasm • Chronic or recurrent infection
- 16. 4. EXCESSIVE LOSSOF CALORIES • Persistent vomiting • Gastro esophageal reflux disease • Gastrointestinal obstruction • Increased intracranial pressure • Renal losses-renal tubular acidosis • Diabetes mellitus • Inborn errors of metabolism
- 17. 5. ALTERED GROWTHPOTENTIAL OR REGULATION • Chromosomal abnormalities • Endocrinopathies
- 18. CLINICAL FEATURES • Height,weight, and head circumference do not match standard growth charts • Weight is lower than 3rd percentile • Growth may have slowed or stopped after a previously established growth curve • Physical skills such as rolling over, sitting, standing and walking decreased • Mental and social skills decreased • Secondary sexual characteristics delayed in adolescents.
- 19. • Constipation • Excessivecrying • Excessive sleepiness (lethargy) • Irritability • Minimal smiling • Avoidance of eye contact • Unresponsive
- 22. HISTORY TAKING • PRENATAL(INTRANATAL) • LABOUR, DELIVERY, AND NEONATAL EVENTS • MEDICAL HISTORY OF CHILD • SOCIAL HISTORY • NUTRITIONAL HISTORY
- 23. EXAMINATION & TESTS •Physical examination • Denver Developmental Screening Test • A growth chart outlining all types of growth • Complete blood count (CBC) • Electrolyte balance • Hemoglobin electrophoresis • Hormone studies, including thyroid function tests • X-rays to determine bone age • Urinalysis
- 25. MANAGEMENT • Children withFTT require 50% of Recommended Dietary Allowance (RDA) of calories for catch up growth. • Correction of any underlying disease • Improvement in care-giver skills. • Regular and effective follow up • Treatment may also involve improving the family relationships and living conditions.
- 26. • Feeding intervalshould not be greater than 4 hours & a maximum time allowed for sucking should be 20 minutes. • Eliminating distractive events • Avoiding excessive fruit juices • For older & young children meals should be last for 30 minutes, solid foods should be offered before liquid, environmental distraction should be minimized.
- 28. PROGNOSIS Normal growth anddevelopment may be affected if a child fails to thrive for a long time. Normal growth and development may continue if the child has failed to thrive for a short time and the cause is determined and treated.
- 30. PREVENTION Initial failure tothrive caused by physical defects cannot be prevented but can often be corrected before they become a danger to the child. Maternal education, emotional and economic support systems all help to prevent FTT in those cases where there is no physical deformity.
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